Prime Therapeutics prefers both cholesterol lowering drugs Praluent® and Repatha® on its national drug list

ST. PAUL, Minn., Dec. 22, 2015 /PRNewswire/ -- Prime Therapeutics LLC (Prime) announced today it will prefer on its national drug list, both Praluent® and Repatha®, cholesterol lowering medicines by Sanofi / Regeneron and Amgen respectively. The two PCSK9 inhibitors (Proprotein Convertase Subtilisin/Kexin type 9) were approved this summer by the U.S. Food and Drug Administration (FDA) as first-of-its-kind drugs to treat people with established cardiovascular disease or a rare genetic condition in which high cholesterol can't be lowered with the use of traditional statins.

This co-preferred decision applies to Prime's commercially insured and managed Medicaid populations, representing nearly 25 million lives. For Prime's one million Medicare members the financial analysis supported covering both drugs, but requires a trial of Praluent first.

"After carefully evaluating both drugs and consulting with our payers, we're extremely confident co-preferring the PCSK9 medicines offers the best care and competitive savings for our members and clients," said Pete Clagett, senior vice president for integrated care and specialty at Prime. "Our independent pharmacy and therapeutic review process deemed these products to be clinically equivalent. Similar pricing, a narrow indication by the FDA, and our management to appropriate use, curbed use of PCSK9s out of the gate, so we were able to take our time and make a thoughtful decision."

Most pharmacy benefit managers have allowed use of PCSK9 inhibitors for secondary prevention to prevent heart attacks. However, Prime's Cholesterol Best in CareTM drug management program has been effectively managing the appropriate use of these two expensive, yet important new therapies. Prime's previous analysis validates that 80% of people with established cardiovascular disease significantly underuse statins. Therefore there is a significant opportunity to optimize statin use even for members who may be eligible for PCSK9 inhibitors.

"When generic statins are priced at pennies on the dollar, compared to PCSK9s priced at more than $14,000 per year, careful management of PCSK9s and driving statin use is clearly the responsible approach," added Clagett. Careful management is also necessary because the drug makers have yet to complete additional clinical trials proving these drugs can reduce heart disease and prevent heart attacks. "Until additional, meaningful clinical trials are completed proving PCSK9s are effective in reducing heart attacks, use of these drugs should remain limited."

As part of Prime's co-preferred arrangement, Prime also negotiated CareCentered ContractsTM (i.e., outcomes-based contracts) with both drug makers. They include an adherence component (Prime and its clients receive additional payments for poor adherence) as well as a utilization "cap" to insulate Prime's clients from unanticipated increases in utilization.

To estimate how covering PCSK9 inhibitors on the health benefit could affect health care spending within a health plan or large employer, visit Prime's drug cost calculator.

About Prime Therapeutics Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members, offering clinical services for people with complex medical conditions. Headquartered in St. Paul, Minn., Prime serves more than 26 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized as one of the fastest-growing private companies in the nation.